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- W2013480213 abstract "Les anticoagulants et anti-agrégants soulèvent des questions fréquentes en traumatologie crânio-cérébrale et vertébromédullaire. Leur utilisation en thromboprophylaxie est elle justifiée par rapport au risque de complication hémorragique ? Comment gérer les patients sous de tels traitements lorsque survient un traumatisme cranien ou rachidien ? Comment traiter une complication thrombo-embolique en neurotraumatologie ? Les auteurs ont recherché dans la littérature les publications abordant ces questions. 51 références ont été analysées en tenant compte de leur niveau de preuve et ont comparé leurs conclusions avec les recommandations professionnelles. L’incidence élevée et les risques des évènements thrombo-emboliques justifient la prévention immédiate par méthode mécanique. Les héparines de bas poids moléculaires peuvent être utilisées après un délai de 24 heures ou de 72 heures en cas d’hématome sous dural ou de contusion hémorragique. En cas de thrombose veineuse symptomatique les filtres caves sont indiqués. En cas d’embolie pulmonaire, une anticoagulation efficace doit être débutée immédiatement avec une surveillance rapprochée, clinique scannographique et biologique Chez un traumatisé cranien ou rachidien sous traitement anticoagulant l’antagonisation doit être immédiate sans attendre le résultat des tests biologiques. Anticoagulant and antiaggregant drugs are often a matter of debate in head and spinal cord injuries. Is their use warranted to prevent thrombosis with regard to the risk of hemorrhagic complications? How should patients on such treatment be managed when a cerebral or spinal trauma occurs? How should thromboembolic complications in neurotraumatology be treated? The authors screened medical publications covering these questions. Fifty-one references were analyzed according to their level of evidence and their conclusions were compared to updated clinical guidelines. The high incidence and risk of thromboembolic events warrant immediate prevention using compression stockings. Low-molecular-weight heparin can be introduced after 24 h or, in case of a subdural or intracranial hematoma, after the 72 h. A temporary inferior vena cava filter is indicated for symptomatic deep venous thrombosis. When pulmonary embolism is diagnosed, an anticoagulant treatment must be immediately started and the patient kept on close clinical, biological, and CT scan observation. Finally, in patients treated with anticoagulation suffering from a head or spinal cord injury, it is necessary to immediately reverse the effect of their treatment and one must not wait for the biological test results." @default.
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- W2013480213 date "2009-12-01" @default.
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- W2013480213 title "Anticoagulants et anti-agrégants en traumatologie crânienne et rachidienne" @default.
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